Immune Checkpoint Inhibitors Safe for Patients With Psoriasis

While immune checkpoint inhibitors (ICIs) were associated with exacerbation of psoriasis, these flares were considered manageable and should not prevent patients with psoriasis from receiving ICIs for their malignancy.

Researchers sought to better define the safety profile and effectiveness of ICIs in patients with psoriasis. Halle et al conducted a retrospective cohort study among eight academic centers, evaluating the safety outcomes of psoriasis exacerbation, immune-related adverse events (irAEs), progression-free survival, and overall survival.

In total, 76 patient outcomes were analyzed. Malignancies included melanoma (n=62, 82%), lung cancer (n=5, 7%), head and neck cancer (n=2, 3%), and other cancers (n=7, 9%). Cancer therapies included anti-programmed cell death (PD) 1 antibodies, anti-cytotoxic T-lymphocyte antigen (CTLA) 4 antibodies, and an anti-PD-1/CTLA-4 combination therapy. Only two patients were on systemic immunosuppression at ICI initiation.

After ICI treatment initiation, 43 patients (57%) experienced a psoriatic flare after a median 44 days. Of these patients, 53% were able to manage their disease with topical therapy alone and 21% needed systemic therapy. ICI was discontinued in 5 patients who experienced a flare. Other irAEs were experienced by 45 patients.

“Patients who experienced [psoriasis] disease exacerbation performed at least as well as those who did not. Thus, pre-existing psoriasis should not prevent patients from receiving ICIs for treatment of malignancy,” concluded the study authors.

Reference
Halle BR, Betof Warner A, Zaman FY, et al. Immune checkpoint inhibitors in patients with pre-existing psoriasis: safety and efficacy. J Immunother Cancer. 2021;9(10):e003006. doi:10.1136/jitc-2021-003066